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Scottish Health Boards' Dental Epidemiological Programme (SHBDEP)

Report of the 1999-2000 Survey of 5 Year old Children

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Appendices

Appendix A	Personnel involved in the survey
Appendix B	Training and calibration
Appendix C	Inter and intra-examiner agreement
Appendix D	Codes used for the assessment of caries and sealants
Appendix E	Abbreviations used for Health Boards
Appendix F	Prevalence of Abscesses
Appendix G	Comparison of "d3mft" and "d3" in 1995 and 1997 with confidence limits
Appendix H	Caries experience and distribution by surface
Appendix I	Oral cleanliness
Appendix J	Maps of d3mft results for Great Britain and Scotland

List of Tables

C1	Inter-dentist agreement from calibration trial
C2	Intra-dentist agreement from survey
H1	Caries data, by surface, for each Health Board
H2	Distribution of decay by tooth surface for each Health Board
I1	Plaque score and associatied d3mft values

List of Figures

F1	Percentage of children with abscesses in each DEPCAT group
G1	Comparison of d3mft in 1997/98 and 1999/2000
G2	Comparison of d3s in 1997/98 and 1999/2000
I1	Distribution of plaque scores in each Health Board
J1	BASCD UK map showing geographical variation in d3mft,1997/98
J2	SHBDEP map showing d3mft by Health Board for 1999/2000

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Appendix A

Participants in the 1999-2000 Survey of 5 year olds

Consultants DPH/CADOs (or their representatives)	Health Board
Mr P Sweeney	Argyll & Clyde
*	Ayrshire & Arran
Mr G Ball	Borders
Mr D Trotter	Dumfries & Galloway
Mr G Ball	Fife
Mr P Sweeney	Forth Valley
Mr M C W Merrett	Grampian
Mr D McCall	Greater Glasgow
Mr C Jones	Highland
Miss MM Taylor	Lanarkshire
Mr G Ball	Lothian
Mrs M Nelson	Orkney
Mr M Collins	Shetland
Mr M C W Merrett	Tayside
Mr J Lyon	Western Isles
* No current incumbent

Health Board Coordinators	Health Board
Mr A C Gerrish	Argyll & Clyde
Mr A J Swan	Ayrshire & Arran
Mr D W Clouting	Borders
Miss L S Gilliat	Dumfries & Galloway
Mrs J Logan	Fife
Mr R Maxwell	Forth Valley
Mr R Hamilton	Grampian
Mr A Kippen	Greater Glasgow
Mrs C Lush	Highland
Mr M Foster	Larkshire
Mrs C Wight	Lothianan
Mrs M Nelson	Orkney
Mr M Collins	Shetland
Miss M M T Curnow	Tayside
Mrs C MacMillan	Western Isles

Dental Examiners / Scribes	Health Board
Mrs E Reilly / Mrs S Kane Mr D	Argyll & Clyde
Mrs L Baker / Mrs M Hutchinson	Argyll & Clyde
Watson / Mrs J Simpson	Argyll & Clyde
Mr A Swan / Ms J Beattie	Ayrshire & Arran
Mrs M Land / Mrs L Dumper	Borders
Mr A Price / Mrs W MacIver	Dumfries & Galloway
Mrs A Milne / Miss H Jeczalik	Dumfries & Galloway
Mrs J Logan / Miss E Pye	Fife
Mr S Watt / Mrs L Scott	Fife
Mr R Maxwell / Mrs E Kerr	Forth Valley
Mr R Stuart / Miss M Nicol	Forth Valley
Miss C Doran / Ms D Lawson	Grampian
Mr R Stuart / Ms M Nicol	Grampian
Mrs M Barr / Mrs J Strong	Greater Glasgow
Mrs Y Blair / Miss C Garton	Greater Glasgow
Mrs A Macmillan / Recorder	Greater Glasgow
Miss T Dunseith / Mrs J McInnes	Greater Glasgow
Miss F Gilchrist / Mrs C Campbell	Greater Glasgow
Mrs D Macadam / Mrs F Campbell	Greater Glasgow
Mr D Macfarlane / Mrs C Harper	Greater Glasgow
Mr P Dunford / Mrs S Thomson	Highland
Mrs C Temple / Mrs M Lornie	Highland
Mr J Sinclair/ Mrs S Dorrian	Lanarkshire
Mr M Foster / Mrs A Kerr	Lanarkshire
Mr J Morrison / Miss J Kerr	Lanarkshire
Mrs Y Millar / Mrs M Hope	Lanarkshire
Mrs R Butchart / Mrs M Brown	Lanarkshire
Miss M Campbell / Mrs E Gilhooley	Lothian
Mrs J Marshall / Mr L Waugh	Lothian
Mrs R McGonigle / Mrs M Slane	Lothian
Mrs M Nelson / Mrs M Tait	Orkney
Mr M Collins / Mrs C Balfour	Shetland
Miss M Curnow / Mrs B Ritchie	Tayside
Miss G Macaulay / Miss C Shand	Tayside
Ms A Macdonald / Mrs F Fenton	Tayside
Miss C Macleod / Mrs N Macsween	Western Isles

Calibration Course Staff Name	Title
Mr M C W Merrett (Tayside Health Board)	Organiser
Prof N B Pitts (Dental Health Services Research Unit)	Coordinator
Dr C Pine (Dental Health Services Research Unit)	Examiner Training
Prof K W Stephen (Glasgow Dental Hospital and School)	Adviser
Ms P A Smith (Dental Health Services Research Unit)	Organisation, Data Collection and Calibration
Dr BC Bonner (Dental Health Services Research Unit)	Data Collection and Calibration
Mrs Lynda Ellis (Dental Health Services Research Unit)	Data Collection and Calibration
Ms K Finlay (Dental Health Services Research Unit)	Data Collection and Calibration
Ms Jenny Johnston (Dental Health Services Research Unit)	Data Collection and Calibration
Dr Z J Nugent (Dental Health Services Research Unit)	Data Collection and Calibration
Mrs T Schmid (Dental Health Services Research Unit)	Data Collection and Calibration

Organisational assistance was provided by staff of the Community Dental Health Service,
Perth and Kinross Healthcare NHS Trust.

Staff Name	Unit
Data Processing
Dr Z J Nugent	(Dental Health Services Research Unit)
Data Entry
Mrs T Schmid	(Dental Health Services Research Unit)
Analyses and Report Preparation
Dr Z J Nugent	(Dental Health Services Research Unit)
Prof N B Pitts	(Dental Health Services Research Unit)
Ms P A Smith	(Dental Health Services Research Unit)

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Appendix B

Training and Calibration

The training and calibration course for this seventh SHBDEP survey of 5 year old children in Scotland was once again held in Perth, as this has proved to be a good central location for all the areas from which examining teams have to travel.

As in previous years, there were a large number of people involved in the organisation and undertaking of the training and calibration and two separate courses were needed to accommodate the teams. The first course was held on Thursday and Friday, 21st and 22nd October, with the second being held on Monday and Tuesday, 25th and 26th October 1999. The courses were undertaken in a hotel in Perth and followed the schedules from previous years. Illustrated training sessions on the codes and criteria, updated to accommodate the latest modifications from BASCD (Pitts ed, 1997), and using the UK BASCD Trainers' Pack (Mitropoulos, Pitts & Deery, 1992) were followed by discussion sessions. Clinical training sessions were undertaken using schoolchildren on the morning of the second day, and were followed by the calibration sessions in the afternoon. Final discussions were held on completion of the calibration. The course organiser was Mr M C W Merrett and the training was provided by Dr Cynthia Pine and DHSRU.

As in previous years, there were a large number of people involved in the organisation and undertaking of the training and calibration and two separate courses were needed to accommodate the teams. The first course was held on Thursday and Friday, 21st and 22nd October, with the second being held on Monday and Tuesday, 25th and 26th October 1999. The courses were undertaken in a hotel in Perth and followed the schedules from previous years. Illustrated training sessions on the codes and criteria, updated to accommodate the latest modifications from BASCD (Pitts ed, 1997), and using the UK BASCD Trainers' Pack (Mitropoulos, Pitts & Deery, 1992) were followed by discussion sessions. Clinical training sessions were undertaken using schoolchildren on the morning of the second day, and were followed by the calibration sessions in the afternoon. Final discussions were held on completion of the calibration. The course organiser was Mr M C W Merrett and the training was provided by Dr Cynthia Pine and DHSRU.

Letham Primary School (Headteacher, Mr J Dempsey) and North Muirton Primary School (Headteacher, Mr P Pierson) kindly allowed the training and calibration courses to take place on their premises. Without the cooperation of the children, their parents and the staff of these schools the courses could not take place. The Scottish Health Boards' Dental Epidemiological Programme is grateful to them all.

References

Mitropoulos C, Pitts NB & Deery C. BASCD Trainers Pack for Caries Prevalence Studies, 1992/93. University of Dundee, 1992.

Pitts NB (Ed) Community Dental Health 1997: Supplement 1. The BASCD coordinated NHS Dental Epidemiology Programme Caries Prevalence Surveys 1985/6 - 1995/6.

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Appendix C

Inter and Intra-examiner Aggreement

Table C1: Inter-dentist Agreement
Group	A	B	C	D
Number of Dentists	9	10	9	7
Number of Subjects	10	9 or 10	10	10
deciduous teeth
Mean	187	156.9	193	157
Standard Deviation	0	0.3	0	0
Range		156-157
d3t
Mean	31.7	15.9	21.3	26.4
Standard Deviation	4.56	3.25	4.33	3.10
Range	26-39	11 to 23	15-26	22-30
mt
Mean	0	28	0	8
Standard Deviation	0	0	0	0
Range
ft
Mean	3.33	0	1.33	3.43
Standard Deviation	1.32	0	0.50	0.79
Range	1-5		1-2	2-4
d3mft
Mean	35.0	43.9	22.7	37.9
Standard Deviation	4.30	3.25	4.47	3.67
Range	29-42	39-51	16-28	32-42
Kappa (surfaces)
Mean	0.67	0.91	0.79	0.80
Standard Deviation	0.06	0.02	0.05	0.04
Range	0.56-0.81	0.87-0.94	0.71-0.88	0.74-0.86
Dice (deciduous teeth)
Mean	1	0.99	1	1
Standard Deviation	0	0.02	0	0
Range		0.96-1
Kappa (teeth)
Mean	0.81	0.91	0.79	0.89
Standard Deviation	0.06	0.04	0.07	0.06
Range	0.66-0.93	0.79-0.97	0.70-0.94	0.76-0.96

Table C2:Intra-dentist agreement for decayed (d3) and filled (f) teeth and surfaces as assessed by Kappa and Dice Similarity measure (value of 1 denotes perfect agreement and value of 0 denotes no agreement).

Examiner Subjects Surface Tooth Kappa Dice Kappa Dice d f d f 1 6 0.96 0.97 no fillings 1 1 no fillings 2 18 0.98 0.96 1 1 1 1 3 20 0.98 0.98 0.86 1 1 1 5 17 1 1 1 1 1 1 6 16 1 1 1 1 1 1 7 19 >0.99 1 0.97 0.99 1 0.91 8 18 0.99 0.99 1 1 1 1 9 21 0.98 0.97 0.98 0.98 0.98 1 10 22 0.98 0.97 1 1 1 1 11 14 0.95 0.88 0.98 0.93 0.88 1 12 11 0.98 0.99 1 1 1 1 13 13 0.98 0.96 0.96 1 1 1 14 12 0.98 0.80 1 0.81 0.80 0* 15 7 0.98 0.96 1 1 1 1 16 15 0.97 0.96 1 1 1 1 17 24 >0.99 0.99 1 0.99 0 0.98 18 25 0.99 1 1 1 1 1 19 27 0.98 0.96 1 0.96 0.95 1 20 16 0.93 0.91 0.99 0.96 0.95 1 21 15 0.98 0.95 1 0.94 0.94 1 22 17 0.96 0.98 1 0.98 0.98 1 23 15 0.96 0.96 0.90 0.97 0.97 0.91 24 31 0.97 0.97 1 0.99 0.99 1 25 25 0.97 1 1 1 1 1 26 17 1 1 1 1 1 1 27 18 0.99 0.93 1 0.94 0.92 1 28 11 0.99 1 no fillings 1 1 no fillings 29 62 0.97 0.95 0.95 0.97 0.96 1 30 26 >0.99 1 1 1 1 1 31 18 0.99 >0.99 1 0.99 0.99 1 32 26 0.97 0.98 0.95 1 1 1 33 24 1 1 1 1 1 1 34 27 0.91 0.90 1 0.88 0.89 0.86 35 29 >0.99 1 1 1 1 1 36 27 0.92 0.84 0.84 0.90 0.90 0.89                 * one tooth with a filling on first examination and a filling + decay on second examination

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Appendix D

Codes used for the assessment of caries and sealants

Tooth Codes	Unerupted	U
Surface Codes	Excluded	9
	Traumatised surface	t
	Present and "sound"	G
	Arrested dentine caries	1
	Decayed (dentine-visual)*	2V
	Decayed (dentine-cavity)*	2C
	Unrestorable	3
	Filled and decayed	4
	Filled, no decay	F
	Filled, needs replacing	R
	Sealed surface, type unknown	$
	Obvious sealant restoration	N
	Crown/advanced procedure	C
		9

* The way in which examiners use these codes precludes a simplistic comparison with what might have been scored prior to the introduction of code 2V.

The survey criteria:

The caries into dentine (d₃) diagnostic threshold is used throughout the SHBDEP and BASCD surveys. This convention ensures comparability with other surveys but specifically excludes all decayed surfaces with "white spot" or "brown spot" caries in enamel. The examinations are clinical field examinations without the benefit of a dental operating light, compressed air, saliva control, radiographs or other diagnostic aids. Examinations by dentists in dental surgeries cannot therefore be expected to yield the same results (SNAP report on dental caries in children - Pitts et al, 1994).

References

Pitts NB, Binnie V, Gerrish AC, Mackenzie NM, Watkins TR. Scottish Needs Assessment Programme Report - Dental Caries in Children. Scottish Forum for Public Health Medicine: Glasgow, 1994.

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Appendix E

Abbreviations used for Health Boards

Health Board Abbreviation Argyll & Clyde A&A Ayrshire & Arran A&C Borders BOR Dumfries & Galloway D&G Fife FIFE Forth Valley FV Grampian GRA Greater Glasgow GG Highland HIG Lanarkshire LAN Lothian LOTH Orkney ORK Shetland SHET Tayside TAY Western Isles WI

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Appendix F

Prevalence of Abscesses

Data were recorded on the presence / absence of dental abscesses in 6964 (99.6%) of the 6994 children attending Primary1 in schools in Scotland who took part in the SHBDEP survey. Abscesses were found in 4.8% (334).

Figure F1: Percentage of children with abscesses in each DEPCAT group

As this is the first time such information has been collected during the SHBDEP Surveys, it cannot yet be established whether this is an increasing problem associated with a change in the provision of general anaesthetics or merely the consequence of continuing high levels of preventable dental disease in deprived children.

In general, children with dental abscesses had poorer dental health. The dmft was higher, and fewer teeth had been restored. They also harboured more plaque. When linked to social deprivation, it is clear that this severe manifestation of tooth decay is linked to DEPCAT scores. While approximately 2% of children from the most affluent parts of Scotland have abscesses, nearly 11% in the poorest areas suffer in this way. However, neither figure is acceptable. In a typical classroom in the most deprived areas of Scotland, two or three children would be expected to suffer from this condition which is best described as a localised area of sepsis in the gum following infection.

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Appendix G

Comparison of d₃mft and d₃s in 1997/98 and 1999/2000 with confidence limits

Figure G1 Decayed, missing and filled teeth (d₃mft) in 5 year old Scottish children in 1997/98 and 19999/2000 - a comparison showing mean values and estimated 95% confidence limits.

Figure G2: Decayed surfaces (d₃s ) in5 year old Scottish children in 1997/98 and 19999/2000 - a comparison showing mean values and estimated 95% confidence limits.

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Appendix H

Caries experience and distribution by surface

Table H1: Mean number of surfaces decayed (d3s - Total, C1, C2, C3), missing* (ms), filled (fs) and sealed/sealant restoration (ss) per child for each Health Board (decay defined as decay into dentine).

d3s       Health Board Total* C1s C2s C3s ms** fs d3fs $s Argyll & Clyde 4.31 0.15 3.56 0.45 1.55 0.50 4.81 0.00 Ayrshire & Arran 3.93 0.06 2.44 1.38 1.60 0.43 4.36 0.02 Borders 1.72 0.22 1.19 0.27 0.93 0.81 2.54 0.04 Dumfries & Galloway 2.76 0.02 2.41 0.29 1.49 0.48 3.24 0.06 Fife 3.19 0.07 2.47 0.60 1.06 0.38 3.57 0.03 Forth Valley 3.72 0.11 2.91 0.62 1.92 0.36 4.08 0.01 Grampian 2.56 0.00 2.20 0.34 1.31 0.64 3.2 0.00 Greater Glasgow 6.91 0.08 5.72 0.92 2.03 0.57 7.48 0.08 Highland 4.14 0.06 3.66 0.33 1.62 0.47 4.61 0.08 Lanarkshire 4.50 0.11 3.68 0.63 1.47 0.45 4.95 0.03 Lothian 3.21 0.02 2.79 0.29 0.97 0.61 3.81 0.02 Orkney 3.63 0.11 2.76 0.59 1.00 0.97 4.61 0.08 Shetland 2.02 0.11 1.56 0.33 0.87 0.50 2.52 1.55 Tayside 3.65 0.03 2.91 0.58 1.60 0.45 4.1 0.01 Western Isles 5.31 0.08 4.48 0.56 0.93 1.50 6.8 0.04 Scotland (weighted values) 4.17 0.07 3.39 0.61 1.49 0.52 4.69 0.04

*Total d3s includes code 4 (decayed and filled surfaces). ** All missing canines and molars considered lost due tocaries (2 surfaces counted for every lost canine and 3surfaces counted for every lost molar).

Table H2: Distribution by tooth surface (M=mesial,O=occlusal, D=distal, B=buccal, L=lingual) for "unrestorabledecay" (C3), total decay (d3), filled (f) as a % of total d3fs, by Health Board (decay defined as decay into dentine).

Health Board M-C3 O-C3 D-C3 B-C3 L-C3 Argyll & Clyde 1.5 2.1 2.1 1.5 2.1 Ayrshire & Arran 3.3 7.8 7.7 5.9 6.9 Borders 1.2 2.8 2.5 1.9 2.3 Dumfries & Galloway 2.4 2.6 1.4 1.2 1.3 Fife 2.8 3.5 4.1 2.8 3.5 Forth Valley 2.8 4.1 3.3 2.3 2.8 Grampian 2.0 1.9 2.2 2.1 2.3 Greater Glasgow 1.8 3.0 2.9 2.1 2.4 Highland 0.8 2.1 1.8 0.9 1.6 Lanarkshire 2.0 3.5 3.1 1.7 2.4 Lothian 1.0 1.8 2.3 1.1 1.5 Orkney 1.8 3.8 2.8 2.2 2.2 Shetland 1.6 4.3 2.4 1.9 2.8 Tayside 1.5 3.8 3.1 2.4 3.4 Western Isles 1.2 2.3 2.5 1.0 1.2 Scotland (weighted values) 1.9 3.2 3.1 2.1 2.6             Health Board M-d O-d D-d B-d L-d Argyll & Clyde 13.9 28.1 16.5 14.4 16.6 Ayrshire & Arran 13.1 28.6 18.9 13.9 15.6 Borders 11.3 17.2 12.6 13.4 13.5 Dumfries & Galloway 14.4 26.9 15.4 12.6 15.8 Fife 13.1 29.3 18.1 13.9 15.0 Forth Valley 14.7 27.4 15.6 15.7 17.7 Grampian 12.6 24.5 14.1 14.2 14.7 Greater Glasgow 14.2 23.4 17.1 17.4 20.2 Highland 11.4 34.5 15.6 11.3 17.0 Lanarkshire 13.2 29.8 15.4 13.3 19.2 Lothian 13.3 29.0 15.5 11.7 14.6 Orkney 11.6 26.6 15.6 10.4 14.7 Shetland 12.6 26.9 12.9 13.4 14.5 Tayside 12.8 31.2 16.3 12.7 16.1 Western Isles 12.2 19.1 14.5 15.5 16.6 Scotland (weighted values) 13.5 27.1 16.3 14.5 17.4             Health Board M-f O-f D-f B-f L-f Argyll & Clyde 1.3 5.5 2.1 0.6 1.0 Ayrshire & Arran 1.0 5.2 1.8 0.8 1.0 Borders 2.3 13.0 7.5 3.7 5.4 Dumfries & Galloway 1.1 8.8 2.6 0.6 1.7 Fife 0.7 5.0 2.6 1.0 1.5 Forth Valley 0.9 4.8 1.6 0.6 0.9 Grampian 2.3 9.0 4.5 1.5 2.7 Greater Glasgow 0.6 3.3 1.8 0.7 1.3 Highland 0.8 4.6 1.8 1.1 1.9 Lanarkshire 1.3 4.7 1.4 0.6 1.1 Lothian 1.6 7.4 3.2 1.4 2.3 Orkney 2.4 10.8 3.7 1.6 2.6 Shetland 1.3 11.5 4.9 0.5 1.6 Tayside 0.9 5.7 2.3 0.7 1.3 Western Isles 2.0 11.4 3.1 2.9 2.7 Scotland (weighted values) 1.1 5.4 2.3 0.9 1.5

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Appendix I

Oral cleanliness: Assessment of plaque for 5 year old children

Extract from training notes:

Aim: A simple determination of the presence of visible plaque on the upper and lower anterior segments of 5 year olds.

Codes*	0	=	teeth appear clean
	1	=	a little plaque visible
	2	=	substantial amount of plaque visible
	9	=	assessment cannot be made (for both segments, if only one segment visible score that)

* A probe is not used for this part of the examination. Consider plaque only, ignore recent debris such as small pieces of crisp found in an otherwise clean mouth immediately after a school lunchtime.

Figure I1: Percentage of children in each health Board recorded as having substantial plaque, a little plaque or no plaque.

Table I1: Mean d3mft and d3t values (appropriately weighted) for children with differing plaque scores.

Plaque Assessment d3mft dt % Males     teeth appear clean 1.84 1.25 49     a little plaque visable 3.62 2.65 53     substantial amount of plaque visible 5.07 3.9 58     All 2.55 1.80 51     Probability* <0.001 <0.001 <0.001

* Probability from linear association statistical tests

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Appendix J

Maps of d₃mft results for the UK and Scotland

Figure J1: BASCD UK map showing geographical variation in dental caries experience (d₃mft) of 5 year old children, 1997/98

Note: Key values on this map are as published in references below and differ from those used in Figure J2.

Pitts NB & Evans DJ. The dental caries experience of 5-year-old children in Great Britain. Surveys coordinated by the British Association for the Study of Community Dentistry in 1993/94. Community Dental Health1995: 12; 52-58.

Pitts NB & Evans DJ. The dental caries experience of 5-year-old children in Great Britain. Surveys coordinated by the British Association for the Study of Community Dentistry in 1995/96. Community Dental Health 1997: 14; 47-52.

Pitts NB, Evans DJ & Nugent Z. The dental caries experience of 5-year-old children in Great Britain. Surveys coordinated by the British Association for the Study of Community Dentistry in 1997/98. Community Dental Health 1999: 16; 50 - 56.

Figure J2: SHBDEP map showing dental caries experience (d₃mft) by Health Board for 5 year old children in Scotland for 1999/2000.

Note: Key values on this map are used in SHBDEP 1993/94, 1995/96 and 1997/98 (referenced below) and differ from those used in Figure J1.

Pitts NB, Fyffe HE & Nugent Z. Scottish Health Boards' Dental Epidemiological Programme, 1993/94 Report. University of Dundee, 1994.

Pitts NB, Nugent Z & Davies JA. Scottish Health Boards' Dental Epidemiological Programme, 1995/96 Report. University of Dundee, 1996.

Pitts NB, Nugent Z & Smith PA. Scottish Health Boards' Dental Epidemiological Programme, 1997/98 Report. University of Dundee, 1998.

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